Abstract
BackgroundDuring the post-partum period, most women wish to delay or prevent future pregnancies. Despite this, the unmet need for family planning up to a year after delivery is higher than at any other time. This study aims to assess fertility intention, contraceptive usage and unmet need for family planning amongst women who are six weeks postpartum, as well as to identify those at greatest risk of having an unmet need for family planning during this period.MethodsUsing the NICHD Global Network for Women’s and Children’s Health Research’s multi-site, prospective, ongoing, active surveillance system to track pregnancies and births in 100 rural geographic clusters in 5 countries (India, Pakistan, Zambia, Kenya and Guatemala), we assessed fertility intention and contraceptive usage at day 42 post-partum.ResultsWe gathered data on 36,687 women in the post-partum period. Less than 5% of these women wished to have another pregnancy within the year. Despite this, rates of modern contraceptive usage varied widely and unmet need ranged from 25% to 96%. Even amongst users of modern contraceptives, the uptake of the most effective long-acting reversible contraceptives (intrauterine devices) was low. Women of age less than 20 years, parity of two or less, limited education and those who deliver at home were at highest risk for having unmet need.ConclusionsSix weeks postpartum, almost all women wish to delay or prevent a future pregnancy. Even in sites where early contraceptive adoption is common, there is substantial unmet need for family planning. This is consistently highest amongst women below the age of 20 years. Interventions aimed at increasing the adoption of effective contraceptive methods are urgently needed in the majority of sites in order to reduce unmet need and to improve both maternal and infant outcomes, especially amongst young women.Study registrationClinicaltrials.gov (ID# NCT01073475)
Highlights
During the post-partum period, most women wish to delay or prevent future pregnancies
The provision of quality family planning services in the postpartum period has the potential to reduce the voluntary termination of unwanted pregnancies and effect a reduction in both maternal and childhood mortality and morbidity arising from unsafe abortions and inadequate spacing of births, respectively [3,4]
This study aims to assess the fertility intention, contraceptive usage and mix, as well as the unmet need for family planning amongst women who are six weeks postpartum using the Global Network for Women and Children’s Health Research’s Maternal and Newborn Health Registry (MNHR), a prospective multicentre active surveillance mechanism on-going in rural communities in five low and lower middle-income countries [33]
Summary
During the post-partum period, most women wish to delay or prevent future pregnancies. Demographic and Health Surveys (DHS) in 27 developing countries conducted between 1993 and 1996 have demonstrated that during the extended post-partum period, up to a year after delivery, most women wished to delay the subsequent pregnancy for two or three years or to prevent any future pregnancies altogether [1]. There are a number of safe and effective contraceptive methods that women can begin at various points after delivery, including those used immediately postpartum, to optimize birth spacing [2]. The provision of quality family planning services in the postpartum period has the potential to reduce the voluntary termination of unwanted pregnancies and effect a reduction in both maternal and childhood mortality and morbidity arising from unsafe abortions and inadequate spacing of births, respectively [3,4]. An early second pregnancy may negatively influence the health, development and survival of the first child [18]
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